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Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis

Journal of Human Hypertension volume 30, pages 355–362 (2016)Cite this article

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Abstract

Owing to antiretroviral drug-induced endothelial dysfunction, HIV-infected patients on antiretroviral therapy (ART) may have elevated blood pressure. We conducted a systematic review and meta-analysis to estimate the effects of ART on blood pressure levels and hypertension risk among HIV-infected populations worldwide. We sought articles that compared the mean blood pressure measurements and hypertension prevalence between HIV-infected adults naive and exposed to ART. Thirty-nine studies comprising 44 903 participants met the inclusion criteria. Overall, systolic (mean difference (MD) 4.52 mm Hg, 95% confidence interval (CI) 2.65–6.39, I2=68.1%, 19 studies) and diastolic blood pressure levels (MD 3.17 mm Hg, 95% CI 1.71–4.64, I2=72.5%, 16 studies) were significantly higher among ART-exposed patients compared with treatment-naive patients. Similarly, the risk of hypertension was significantly higher among ART-exposed patients, such that among 28 908 ART-exposed patients, 4195 (14.5%) had hypertension compared with 950 of 9086 (10.5%) in those who were treatment-naive (odds ratio 1.68, 95% CI 1.35–2.10, I2=81.5%, 32 studies). In summary, exposure to ART is significantly associated with increased systolic and diastolic blood pressure levels, and increased risk of hypertension, regardless of study-level sociodemographic differences. This meta-analysis supports the need for population-based strategies to reduce the risk of high blood pressure among people living with HIV on ART.

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Acknowledgements

CUN acknowledges the support from the University of Warwick Scholarship (Warwick ID 1160088). OAU acknowledges the support from the FAS Marie Curie International PostDoc (2012–0064).

Author contributions

CUN conceived of the study and participated in designing the study, data acquisition, meta-analysis and interpreting the data and drafting the manuscript. AMS participated in data acquisition and drafting the manuscript. OAU participated in designing the study, meta-analysis and interpreting the data. CUN, SS, PKK and OAU critically revised the manuscript. All authors have read and approved the final manuscript.

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Authors and Affiliations

  1. Division of Health Sciences, Warwick Medical School, University of Warwick Medical School, Coventry, UK

    C U Nduka, S Stranges, A M Sarki & P K Kimani

  2. Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg

    S Stranges

  3. Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick Medical School, Coventry, UK

    O A Uthman

  4. Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK

    O A Uthman

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  1. C U Nduka
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Correspondence to C U Nduka.

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Nduka, C., Stranges, S., Sarki, A. et al. Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis. J Hum Hypertens 30, 355–362 (2016). https://doi.org/10.1038/jhh.2015.97

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